Your question is an interesting one. I will try my best to answer the query.

Vasovagal attacks in the elderly is a difficult problem to treat. I assume that the diagnosis of Vasovagal Syncope has been confirmed already. He is already on medicines like Zolfot and Midodrine which help in vasovagal attacks. If he is not responding to these medicines he can be tried on Betablockers like Metoprolol, and Fludrocortisone which increases the salt content in the body.

If he does not respond to these then only option is to go for permanent pace maker implantation.

Other precipitating factors, such as prolonged standing or sitting, excess alcohol intake and exercising after large meals or in a hot environment should be avoided.